Introduction:
Credit: Iqbal Osman1 from singapore, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons
As eye care professionals, ophthalmologists play a crucial role in diagnosing and treating a wide range of ocular conditions. Among these, fungal keratitis stands out as a severe and debilitating eye infection that demands our attention. This neglected tropical disease primarily affects the cornea and carries a significant health and socioeconomic burden, especially in tropical and subtropical regions. Despite its devastating consequences, fungal keratitis has yet to receive the recognition it deserves on a global scale. In this blog post, we delve into the importance of acknowledging fungal keratitis as a neglected tropical disease from a scientific perspective, backed by research and evidence.
Understanding Fungal Keratitis
Fungal keratitis is an ocular emergency characterized by a severe infection of the cornea, the transparent outer layer of the eye. It predominantly affects individuals residing in tropical and subtropical climates, where it accounts for a considerable percentage of culture-positive corneal infections. Common causative agents include filamentous fungi like Fusarium spp. and Aspergillus spp. Prompt diagnosis and treatment are essential to prevent irreversible corneal destruction, vision loss, and eye loss.
Epidemiology and Association with Poverty
Fungal keratitis poses a significant burden on public health, particularly in resource-limited settings. The incidence of fungal keratitis varies widely, with the highest rates reported in South Asia and the lowest in Europe. In countries like Pakistan, East Africa, Germany, and Thailand, a substantial number of patients require eviscerations due to fungal keratitis, leading to the loss of thousands of eyes each year. It is estimated that between 1 and 1.4 million new cases of fungal keratitis occur annually worldwide.
Several risk factors for fungal keratitis are closely associated with poverty and agriculture. Ocular trauma from organic or vegetative matter, common among agricultural or outdoor workers, is a leading cause of fungal keratitis. Immunosuppressive conditions, including HIV/AIDS, also increase susceptibility to the disease. Poor sanitation and limited access to proper eye care contribute to late presentations and delays in appropriate treatment, leading to severe complications like corneal ulceration, scarring, and perforation.
Diagnostic Challenges
Diagnosing fungal keratitis poses challenges due to the diverse spectrum of causative agents. Traditional microbiological techniques, such as corneal scraping for microscopy and culture, are not uniformly available in low-resource settings. Moreover, culture-negative cases, despite high clinical suspicion, underscore the limitations of these techniques.
In recent years, new diagnostic tools, such as in vivo confocal microscopy (IVCM), anterior segment optical coherence tomography (AS-OCT), and polymerase chain reaction (PCR), have shown promise in identifying fungal elements with higher sensitivity and specificity. However, accessibility to these advanced technologies remains limited in resource-limited regions.
Treatment Approaches
Medical management of fungal keratitis is the primary approach, with topical antifungal drugs being the first line of treatment. Topical 5% natamycin, listed as an essential medicine by the World Health Organization (WHO), has shown favourable treatment responses in many cases. However, delayed presentation often complicates the effectiveness of treatment, necessitating surgical interventions like debridement, conjunctival flaps, and penetrating keratoplasty.
The prolonged duration of treatment and the high costs of antifungal medications contribute to the significant economic burden of fungal keratitis. Moreover, the lack of point-of-care tests and the need for skilled operators further hinder timely and accurate diagnosis, especially in remote settings.
Reasoning for Recognition as an NTD
As ophthalmologists, we witness the devastating impact of fungal keratitis on individuals and communities. Recognizing fungal keratitis as a neglected tropical disease is essential for several reasons:
- Public Health Priority: Recognition as an NTD by global health authorities would elevate the priority of fungal keratitis, leading to the implementation of prevention and awareness programs.
- Improved Diagnostic and Treatment Resources: NTD status would encourage research and funding to develop more accessible and effective diagnostic tools and antifungal medications suitable for resource-limited settings.
- Enhanced Training and Education: Healthcare professionals, including ophthalmologists and community health workers, would receive specialized training and education on early recognition, diagnosis, and management of fungal keratitis.
- Collaboration and Advocacy: NTD status would foster international collaboration between governments, NGOs, and healthcare organizations to address the disease’s impact on communities.
Conclusion
Fungal keratitis is a severe eye infection with a profound health and socioeconomic burden, primarily affecting individuals in tropical and subtropical regions. As eye care professionals, we have a unique opportunity to advocate for the recognition of fungal keratitis as a neglected tropical disease. With greater recognition, we can work towards improved diagnostics, treatment options, and prevention strategies to reduce the incidence of this devastating ocular condition. By collaborating on a global scale, we can bring much-needed attention to fungal keratitis and ensure that no patient’s vision is compromised by this neglected tropical disease.
Top image Credit: Photo Credit:Content Providers(s): CDC/Dr. Thomas F. Sellers/Emory University, Public domain, via Wikimedia Commons
